Wednesday, October 30, 2013

An Epidemic Out of Control: Poor Children and Psychiatric Drugs

An excellent, but in its own way truly horrifying
presentation was given at the recent annual meeting of the American Society for
Bioethics and Humanities in Atlanta by Dr. Melody J. Slashinski of the Center
for Medical Ethics and Health Policy at Baylor College of Medicine up the road
in Houston. Her account of some of the fallout from intensive marketing of
psychotropic drugs suggests a serious public health threat to the well-being of
children.

Dr. Slashinski presented the findings of a
participant-observer study of African-American single moms trying to raise
their kids in a public housing project in Houston. The material she reported
was impressive in showing the extent to which she gained the trust of this
community and got her informants to reveal things they would normally keep
hidden from outsiders. In response to a question about this Dr. Slashinski said
that the nickname given to her among this community was “the keeper of secrets.”

Dr. Slashinski reported an effective folk-knowledge network
that linked these mothers and that conveyed information about the dangerous
side effects of drugs commonly prescribed for kids today for ADHD, bipolar
disorder, etc. I doubt these mothers had read Robert Whitaker’s Anatomy of an Epidemic:

That might sound easy to do, but the data went on to show
that it’s extremely difficult in this population especially. The mothers also
feared, quite realistically, that any evidence of “medical noncompliance” on
their part would end up with a report to Protective Services and eventually
losing custody of their children. So the stories Dr. Slashinski told generally
depicted a delicate balancing act—moms on the one hand certain that they would
not give these medicines to their children, and on the other hand going through
as many hoops as they could to appear compliant and submissive to
the medical system so as not to set off alarms.

There was another group of mothers who were intent on
protecting their children—but they elected to do so by giving the medications
despite their fear of side effects. This strategy was based on a sort of pact
with the devil—if they gave the children meds then the outer world might be
compassionate and regard their children as sick, whereas if they withheld the
medications, the world was almost sure to regard their children as bad.
Being seen as bad was viewed by these moms as much more dangerous for the kids
than being sick.

The other reason saving your kids from the harms of these
drugs is difficult was illustrated by an account Dr. Slashinski gave of one
pediatrician office check-up visit with a mom, a 9-year-old son, and 8-year-old
daughter that she personally witnessed. The son had already been diagnosed with
ADHD and the mom had not admitted to the pediatrician that she was not giving
the son his meds (even though overall the mother liked and trusted this
pediatrician a lot). As the doctor entered the exam room, she wheeled in a cart
laden with equipment such as tongue depressors, and the son immediately went to
the cart and started rummaging through it. The doctor used this as a launch for
a lecture to the mom on how the son clearly had serious ADHD and really needed
his medications.

The doctor then examined the daughter and said something at
one point about her “boobies.” The daughter apparently became offended by this
comment and stopped cooperating with the exam. The doctor immediately asked the
mother how often the daughter had these “tantrums” and started talking about
the possibility of bipolar disorder. The visit ended with a psychiatric
referral to evaluate the daughter and a new prescription for the ADHD
medication for the son. The mom told Dr. Slashinski that she would continue to
withhold the son’s medicine, but felt she needed to take the daughter to see
the psychiatrist for fear of the consequences of being “noncompliant” if she
didn’t.

OK, that’s the data presented by Dr. Slashinski; here’s my
comment. Whitaker and others have demonstrated that the sheer number of kids
now being prescribed medicines for ADHD, bipolar disorder, and other
psychiatric diagnoses is so massive that there can be no biological explanation
for how such a huge percentage of the pediatric population of the U.S. suddenly
became crazy. The only possible scientific explanation for this phenomenon is overdiagnosis
and consequent overuse of medicines whose long-term safety in kids has never
been shown, and whose short- and long-term adverse consequences are legion. It
is not only psychiatrists but my fellow primary care physicians (as shown by
the pediatrician in the case study) who have bought into this insane model of
diagnosis and treatment—not the least because of how quick it is to slap on a
diagnosis and write a prescription, and how hard (indeed, in cases like this,
nearly impossible) to fully inquire into the child’s psychological and social
environment and then identify helping interventions if needed. Are things
truly so bad that the only way parents can protect their kids is by not taking
them to the doctor?

Everything I just said applies to the American society at
large. But now, back to Dr. Slashinski’s data, we see that when American
society gets the sniffles, poor minority populations come down with pneumonia.
It appears to be the new social campaign to get all kids to be as passive and
submissive as possible, no matter how much we have to drug them. But this is
especially true of black kids, especially black males, who as shown by the
Trayvon Martin case can be thought to pose a threat to the lives and safety of
the white community merely by existing—let alone by acting curious and
assertive. So the call goes out even more shrilly to diagnose this group of
children and medicate them, and the parents have even less social authority and
credibility to question this.

In short, the epidemic of psychiatric overdiagnosis and
overtreatment that Whitaker identified is truly out of control, if Dr.
Slashinksi’s findings are in any way representative. And the medical and
medical-scientific community bears major responsibility for this state of
affairs.